Table 2 Included articles exploring adaptation of newly graduated nurses

Abiodun, et al. [42] South Africa

To investigate use of an Instant Messaging application (WhatsApp) community of practice to support graduate nurses in their first year of practice in the Western Cape,

South Africa

Quantitative approach; Employing self-developed questionnaire based on the Technology Acceptance Model

Participants

198 final year Bachelor of Nursing students and 150 employed nurse graduates

Factors supporting

graduate nurses in their first year of practice:

1. Interactions with alumni,

2. Bridging and bonding

social capital,

3. Professional integration

4. Sense of belonging

5. Application of theory

to practice

Social-emotional

support

Social construct

Social belonging

Pre-entry

knowledge/experience

Numerous confounders may exist such as different levels of

support in community

service placement sites

which the researchers

were not able to quantify during the study

Ashton [1]

United

States

To explore adaptation of new

registered nurses

using the Roy

adaptation model

as the guiding

conceptual

framework

A quantitative approach using cross-sectional design employing single item

adjustment scale, the occupational fatigue exhaustion recovery (OFER) scale, and the job-related affective well-being Scale (JAWS)

Participants

250 registered nurses in North Carolina (NC)

Being in a formal

orientation period

significantly supported

newly graduated nurses overall adaptation

Factors facilitating the

adaptation:

1. Personal attributes

2. Characteristic of work

setting

3. Social support

4. Nursing education

Self-Confidence

Socio-emotional

support

Shift hours

Long working hours

Pre entry-

knowledge/experience

Single item adjustment

scale has low validity and

reliability to measure the

adaptation. These measurements did not

comprehensively capture nor adequately measure new RNs’ adaptation

Bisholt [22]

Sweden

To describe and analyse how recently graduated nurses are socialised into the profession

Qualitative approach using ethnography through participant observations and interviews

Participants

16 novice nurses working at a county hospital in the central part of Sweden

Physicians doubted nursing knowledge and occupational performance of newly graduated nurses because they were unable to prove their professional abilities

Stress between nursing academia and organisation. In nursing education, the ideology of nursing was prominent, but within the profession emphasis was on good occupational skills

Hierarchy culture- newly graduated nurses felt being excluded in the team. Seniors did not acknowledge their existence, ignore and blame newly graduated nurses for the mistake. Confidence

level deteriorated

Nursing faculty role Pre-entry knowledge/experience

Masking personality self-confidence

The study focused on an investigation of a small number of new graduated nurses

Chandler [43]

United States

To focused on the new graduates’ perspective of the processes that enabled them to successfully integrate into their new role:

to learn the processes necessary for a successful transition to describe effective supports for newly graduated nurses to develop the knowledge, skills, and attitudes needed to progress through

the first year of practice

A qualitative descriptive design

Participants

36 nurses who had graduated from associate degree (20%) and baccalaureate (80%)

programs

Three themes were identified:

‘‘They were there for me,’’

‘‘There are no stupid questions,’’

‘‘Nurturing the seeds.’’

Social emotional support

Social construct Constructive feedback Welcoming culture Team work

Work delegation Prioritising

Time management Nursing faculty role knowledge/experience- newly graduated nurses perceived well prepared

There was no explicit explanation for the difference in adaptation processes between nurses with an associate degree and those in baccalaureate programs

Feng and Tsai [44]

China

To explore socialisation experiences of new graduate baccalaureate nurses to practising nurses

Qualitative descriptive approach

Data collected using semi-structured, open-ended, in-depth interviews analysed by content analysis

Participants

Seven newly graduated nurses working in four medical centers in Taiwan

Practicum inadequately exposed newly graduated nurses to actual responsibilities and clinical experiences. Newly graduated nurses perceived organisational socialisation process involved interpersonal relationships and adapting themselves with ward rules and culture was the hardest work

Socialisation process involved three themes: ‘Learning by doing’ was the strategy that helped newly graduated nurses’ transition from ‘overwhelming chaos’ to ‘being an

insider’

Social construct Social acceptance Coping skill (learning by doing)

Proactive Confidence

This study involved small sample; thus, the results cannot be generalised

Frögéli et al. [45]

Sweden

To prospectively investigate how socialisation processes relates to experiences of stress among newly graduated nurses during the first three months of professional working life

Quantitative approach using longitudinal study with employing Stress and Energy Questionnaire), Gener al Questionnaire for Psychological and Social Factors at Work), Needs Satisfaction and Frustration Scale

Participants

264 newly graduated Swedish nurses who started their first jobs during the period of the study

Socialisation processes affected newly graduated nurses’ experiences of stress. Factors to reduce stress to improve socialisation process involved:

Role clarity

Task mastery skills

Social acceptance

Proactive. Onboarding phase was different between individuals. Newly graduated nurses who were in late phase of onboarding scored high in task mastery and role clarity but lower in social acceptance

Social acceptance

Role clarity

Task management Proactive

Causality of effects cannot be determined

Hunter and Cook [46] New

Zealand

To explore new graduate nurses’ experiences of professional socialisation by registered nurses in hospital-based practice settings, and identify strategies that support professional

identity development

A qualitative descriptive design using semi-structured interviews

Participants

5 newly registered nurses employed within one New Zealand region for less than six months were recruited

Three themes describe the nurses' experiences of professional socialisation:

‘Lessons from the wilderness'

‘Life in the wild’

‘Belonging to a wolf pack’

Social support working atmosphere Feedback

Self-confidence

Small sample size and homogenous participants in aspect of gender, age and ethnicity

Kramer, et al. [47]

United States

To identify to what extent Nurse Residency Programs reflected the professional socialisation

To determine which components, strategies, and activities of Nurses Residency Program were most effective in Newly Licensed Registered Nurses socialisation into professional practice

A mixed-method design

Descriptive, quantitative data obtained from 37- items Residency Program Questionnaires (RPQs). Small group or individual interviews of newly graduated nurses was performed

Participants

Descriptive, quantitative data obtained from 34 hospitals

Qualitative data obtained from 330 newly graduated nurses, 401

preceptors, 138

managers, and 38 educators

Components in the Nurse Residency Programs (NRPs) that reflected the professional socialisation process:

Precepted role (to provide the situated learning, positive feedback/motivation to restore confidence, and guide to solve problems, task mastery, delegation and work prioritisation)- effective strategies for newly graduated nurses’ integration

Reflective seminars,

Skill acquisition,

Reflective practice sessions,

Evidence-based management projects,

Clinical coaching– mentoring sessions

Social-emotional support

Received constructive feedback

Work performance Self-confidence

Small group or individual interviewed session is time consuming, energy and resources

Challenging in scheduling a group (discussion goes beyond the schedule time)

Kramer et al., [14]

United States

To identify effective components and strategies of Nurse Residency Programs (NRP) in each area

Qualitative approach using individual and focus group interview

Participants

907 nurses in 20 Magnet hospitals with NRPs operative for at least 3 years participated in individual or small group interviews and 82 participant observations

Factors to promote integration in the transition phase were:

Provide nursing students with experience of professional practice role and management of clinical situations

Support them with discussion and activities to help them prioritise and delegate tasks,

Conflict resolution—improve social development

4. Constructive feedback can restore and augment self-confidence

Prioritising skills Decision-making Problem-solving Communication

Collaborative relationship

Feedback

Work delegation Get work done Confidence values

Small group or individual interviewed session is time consuming, energy and resources

Challenging in scheduling a group (discussion goes beyond the schedule time)

Lalonde et al. [48]

Canada

To explore relationships between preceptor characteristics (emotional intelligence (EI), personality (P) and cognitive intelligence (IQ)) and new graduate nurse socialisation outcomes regarding turnover intent, job satisfaction, role conflict and ambiguity

A quantitative approach using cross-sectional design employing demographic

questions, Nursing Emotional Intelligence Scale (NEIS), Cattell Culture Fair Intelligence Test and International Personality Item Pool (IPIP) short scale to measure preceptors EI, IQ and personality, respectively

Participants

41 preceptors and 44 new graduates completed a quantitative survey at the end of their preceptorship program

Preceptor personality traits of openness, conscientiousness and emotional stability were significantly related to new graduate nurses who reported greater turnover intent, job dissatisfaction, role conflict and ambiguity

No significant relationships were noted between preceptor EI and IQ and the outcome of new graduate nurses

Role clarity

Social-emotional support

Eligible nurses may not have been sampled or participated because there were changes in newly graduated nurse’s recruitment practices in Ontario during the study period

Lee et al. [49]

China

To obtain a comprehensive understanding of the transition process of newly graduated nurses in Taiwan

Qualitative phenomenological approach using focus group interviews

Participants

16 novice nurses from one teaching hospital in the central part of Taiwan

Concentrating to become insiders was important to survive and adapt during the transition phase. This phenomenon was characterised by four themes identified for being accepted:

‘being new as being weak’,

‘masking myself’,

‘internalising the unreasonable’ and

‘transforming myself to get a position’

Social acceptance Masking personality Self-embodiment

Generalisation is limited as it only involves sample in teaching hospitals

Leong et al. [50]

Singapore

To explore perceptions of newly graduated nurses of their experiences of role transition. To examine implications for managers in terms of employee training, development and retention

Qualitative constructivist grounded theory approach using semi- structured interviews

Participants

26 nursing students across five hospitals

Two major constructs appear to play an important part in the transition process:

Learning how to fit in (facilitated by social interaction including observing and questioning others and seeking out social support)

Aligning personal with professional and organisational identities (displaying positive attitudes, developing professional identity)

Socio-emotional support

Social construct Working atmosphere Masking personality Self-confidence

The study investigated the graduated nurses and preceptors’ experiences and did not examine the senior hospital managers, human resource managers and nursing educators who may have contributed additional understanding

to the data

Li et al. [51] China

To investigate newly graduated Chinese nurses' intention to leave their jobs and to explore association of intention to leave with nurse characteristics, per- son– environment fit, and social support

Quantitative approach using cross-sectional design employing single item of negative events, six- item Turnover Intention Scale, Perceived Person Environment Fit Scale, 10-item Proactive Personality Scale, and Multidimensional Scale of Perceived Social Support (MSPSS),

Participants

1313 newly graduated nurses from 18 hospitals in six provinces

Reasons of newly graduated Chinese nurses considered leaving their jobs:

Low degree of person- organisation fit

High level of education Exposed to negative workplace

Proactive personality

Social-emotional support

Working atmosphere- deteriorated

Self-confidence

Shift hours Proactive

Cross sectional design did not permit causality measurements. Single question to measure participants' experiences of negative events could not reveal the exact relationship between these variables and NGNs' intention to leave

Malouf and West [52] Australia

To provide insight into how Australian New Graduate Nurses (NGNs)

experienced their transition to acute care nursing practice

Qualitative approach using serial in-depth interviews

Participants

Nine intensive interviews were conducted among newly graduated nurses who employed in public and private hospital

Needs of newly graduate nurses in adaptation process in the context of socialisation:

Establish relationships to build up the sense of being insider

Should not to appear ‘stupid' in front of staff members

Reduce the ward rotation -to reduce the stress of fitting-in for the beginner

Social belonging Working atmosphere

There was no explicit explanation for the difference in adaptation processes between nurses employed in public and private hospital

Ohr et al. [53] Australia

To investigate if current onboarding process influenced organisational socialisation of new graduate nurses and midwives into the workforce

Quantitative approach using cross-sectional

design employing 41 items on researcher developed questionnaires

Participants

170 novice nurses who commenced their transition program in the health District in January and February 2017

Onboarding practices in the context of organisational socialisation were:

Relationship building was the main key in organisational socialisation

Ability to learn workplace cultural norms

Social support from preceptor

However:

Study address the inconsistency in the structure and content of orientation programs

Current onboarding did not adequately provide strategies to build relationships for new graduates within their work environments-preceptor have role ambiguity

Social-emotional support

Welcoming culture

Working atmosphere Prioritising skills Coping skills

Time management Problem solving Communication skills Team work

The study focused on an investigation of a small number of new graduated nurses

Pettersson, and Glasdam [54]

Sweden

To explore newly employed nurses’ socialisation in the process of introduction

into an oncological clinic from the perspectives of unit managers and newly employed nurses

Qualitative approach using semi-structured interviews

Participants

Written introductory material and interviews with seven newly graduated nurses and two-unit managers

Newly graduated nurses were socialised gradually through mirroring their supervisors in their role as nurse. Patients were function as an object for training purposes. Patients also being as the communication object for newly graduated nurses socialised with all staff

Social-emotional support

Social construct Working atmosphere

There is difference between what people are doing in situ and what they say about their practices. Narratives change over time and it is articulate in space and time. However, this study does not capture these differences; neither does it capture the perspectives of supervisors

Qiao et al

[55]

China

To examine relationships between demographic characteristics, sources of nursing stress and coping strategies, and psychological well-being within graduate nurses

Quantitative approach using four questionnaires; Demographic Questionnaire, The Nursing

Stress Scale (NSS; [56], The Brief Cope Questionnaire [57], and the General Health Questionnaire (12-version, GHQ- 12 [58];)

Participants

96 participants from four hospitals in central China

Organisational sources of stress:

Dealing with death and dying was the most common workplace stressor,

Heavy workload, Feeling a lack of adequate preparation

Adaptive coping strategies to handle work stress were:

Planning Acceptance Positive reframing

Work allocation

Work characteristic Social acceptance Self-confidence Socio-emotional support

Some instruments used were developed in Western countries, and they may not have been validated for use with a mainland Chinese population

Rush et al. [59]

Canada

To examine relationships between selected components of new graduate nurse transition programs and transition experiences

Quantitative approach employing online survey using The Casey Fink Graduate Nurse Experience Survey

Participants

1008 new registered nurses working in acute care

Orientation and transition program component predictors of new graduate workplace integration:

Orientation length (should be at least four weeks in length)

Average number of hours worked in a two- week period (communication and leadership skills of newly graduated nurses who work at least 49 h in a two-week period significantly higher as compared to newly graduated nurses working 48 h and less)

Percentage of preceptor shifts (statistically insignificant)

Socio-emotional support

Long working hour Working atmosphere Prioritising skills Communication skills

Low response rate of 26% may have resulted in a biased sample

Many unexplained variances in transition scores

Sparacino,

[7]

United States

To identify nursing faculty behaviors that reduced stress and anxiety experienced by new graduate nurses as they transcended from role of student to professional registered nurse

Qualitative grounded theory approach using

telephone interviews

Participants

13 new registered nurses who successfully passed the National Council Licensure Examination—Registered Nurse (NCLEX-RN) on the first attempt

Faculty behaviours that helped prepare nursing students meet organisational demands and facilitate adaptation process during transition:

Caring (newly graduated nurses ease of seeking help from faculty)

Rigor (newly graduated nurses valued the nursing faculty who adhered to strict policies, assignments, appearance and punctuality),

Experience (use of simulations with critical cases derived from real experience taught students how to use critical thinking and reasoning skills in high stress situations),

Knowledge (vast knowledge, real-life case studies, use of multiple technological venues in the classroom and clinical setting, motivated students to study harder),

Professionalism (know how to act and behave professionally- help in social development)

Pre-entry knowledge Nursing faculty role Self-confidence Proactive

Study limitations include the researcher’s previously held assumptions, the participant pool, and use of grounded theory

Supplementary research is needed to further validate the theory

Tastan et al. [60]

Turkey

To identify factors affecting the transition period of newly graduated nurses

Quantitative approach using survey

Participants

263 newly graduated nurses working in a military education and research hospital

To facilitate newly graduated nurses’ adaptations to their new roles and in improving their learning:

1. Being/participating in the orientation programs (engagement with the preceptor)

newly graduated nurses experienced reality shock in their working situations:

Inadequate preparation in nursing program for their future professional lives

Lack of support- working with nurses who were unwilling to help

Longer working hours (more than 12 h) negatively affected their performance and work- life balance

Social acceptance Social support

Long working hours Pre-entry knowledge/experience

No validity and reliability tests in the Turkish scale

Long data collection may cause measurement and time period bias

Tomietto et al. [61]

Italy

To determine which organisational socialisation contents affect turnover intention in newcomer nurses within their first 2 years of employment

Quantitative approach with cross- sectional design employing organisational socialisation inventory (OSI), and four items turnover intention scale by Kelloway (1999)

Participants

156 newly graduated nurses

Identified important aspects for newly graduated nurses to focus during the onboarding process to help adaptation with organisational demands:

Need to understand written or unwritten rules and culture to regulate organisational life in the first 6 months of employment

Need to focus on relationships with co- workers

Focus on individual level of task mastery in the 7–12-month period

Focus on professional

development opportunities

Nurse Faculty role Social construct

Work performance- Task mastery

Role clarity

This study employed a cross-sectional design, while organisational socialisation needs to be explored as a longitudinal phenomenon

Wahab et al. [20] Singapore

To explore new graduate nurses' accounts of resilience and facilitating and impeding factors in building their resilience

Descriptive qualitative design using photovoice and focus group interview

Participants

9 new graduate nurses who completed degrees from a Singapore university

Factors impeded development of newly graduated nurses’ resilience to facilitate the adaptation process:

Resilience was persevering and overcoming the obstacles

Resilience was accepting one’s responsibilities and fulfilling them

Resilience was adapting to new situations

Resilience was taking control of own learning

Factors facilitating adaptation process during the transition phase:

1. Participating in orientation program: engaging/working with preceptor, constructive feedback helped with more resilience and gaining confidence

2 Participating in the residency program: effective communication and conflict management to prepare newly graduated nurses to survive in the clinical area

Warm and culture supported adjustment process

Working atmosphere Prioritising skills Time management Problem solving skills Communication skills

Recruitment of participants only from nursing graduates from only one university and one hospital in Singapore

Small sample size

Yildiz and

Ergün [62] Turkey

To reveal transition experiences of nurses in the first year of their profession

Qualitative approach using

semi-Structured, in- depth individual interviews

Participants

30 newly graduated nurses, working in three Training and Research Hospitals, two University Hospitals and three Private Hospitals

Experiences of nurses in their first professional year:

Emotional (experienced frustration and intense anxiety),

Sociocultural and developmental (development of professional identity, being accepted by the team, balancing work and private life and transferring education received into practice),

Physical and intellectual (transferring knowledge they learned during their education to practice)

Newly graduated nurses easily adapted in the transition phase if they:

Received support, constructive feedback, sincerity and consistency of relationships

Received appropriate expectations from seniors off newly graduated nurses

Had the ability to implement and transfer knowledge learned in nursing education to practice

Had the ability to achieve person-organisation fit

Social acceptance Social emotional support

Social construct

Pre-entry

knowledge/experience

Work allocation Feedback

Results cannot be generalised because study only reflects the opinions of newly graduated nurses who participated in the study